Verruciform xanthoma: histopathologic findings and pathogenesis. Analysis of vulvar and perianal cases.
Keywords:
xanthomatosis, foamy cells, necrosis, lipids, etiologyAbstract
Xanthoma verruciform is an inflammatory, reactive, non tumoral lesion. It is common in the oral mucosa, mucocutaneous junctions, and skin of the distal limbs. Clinically, the lesion appears as a solitary, exophytic mass with a rough or verrucous surface. Histological characteristic features are epidermal hyperplasia, marked parakeratosis with exocytosis of neutrophils and aggregates of foamy macrophages in the papillary dermis. Several hypotheses have been proposed to explain the xanthoma verruciform origin, which include infectious mechanisms, metabolic disorders, local irritants, chronic inflammation, and trauma. The most accepted theory proposes as the initiating event damage to the keratinocyte with shed products and lipid formation that induce an inflammatory response, with secondary accumulation of foamy cells in the papillary dermis. Additionally there is a secondary reactive epidermic proliferation. The differential diagnosis should be made with condyloma acuminatum, squamous cell carcinoma, and granular cell tumor. We review the pathogenesis of xantoma verruciform and present two cases in perineal skin with their characteristic histopathological features.
Author Biographies
Viviana Leticia Arias
Profesora asistente de Patología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
Gerzaín Rodríguez
Catedrático, Facultad de Medicina, Universidad de La Sabana, Chía, Cundinamarca; profesor titular y Maestro universitario, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, D.C., Colombia.
References
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2. Nowparast B, Howell FV, Rick GM. Verruciform xanthoma. A clinicopathologic review and report or fifty-four cases. Oral Surg. 1981;51:619-25.
3. Yu CH, Tsai TC, Wang JT, Liu BY, Wang YP, Sun A, et al. Oral verruciform xanthoma: a clinicopathologic study of 15 cases. J Formos Med Assoc. 2007;106:141-7.
4. Weedon D, editor. Cutaneous infiltrates non lymphoid. In: Skin pathology. London: Churchill Livingstone; 2002. p. 1077-8.
5. Mouncastle EA, Lupton GP. Verruciform xanthomas of the digits. J Am Acad Dermatol. 1989;20:313-7.
6. Chyu J, Medenica M, Whitney DH. Verruciform xanthoma of the lower extremity: Report of a case and review of literature. J Am Acad Dermatol. 1997;17:695-7.
7. Neville B. The verruciform xanthoma. A review and report of eight new cases. Am J Dermatopathol. 1986;8:247-53.
8. Philipsen HP, Reichart PA, Takata T, Ogawa I. Verruciform xanthoma-biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan. Oral Oncol. 2003;39:325-36.
9. Hu JA, Li Y, Li S. Verruciform xanthoma of the oral cavity: Clinicopathological study relating to pathogenesis. Report of three cases. APMIS. 2005;113:629-34.
10. Connolly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD. Management of cutaneous verruciform xanthoma. J Am Acad Dermatol. 2000;42:343-7.
11. Li H, Lambert WC. Verruciform xanthoma. eMedicine Fecha de acceso: 2 de octubre de 2009. Disponible en: http://www. emedicine.com/derm/topic852.htm.
12. Miller AS, Elzay RP. Verruciform xanthoma of the gingiva: report of six cases. J Periodontol. 1973;44:103-5.
13. Hume WJ, Smith CJ, Franklin CD. Verruciform xanthoma. Br J Oral Surg. 1980;18:157-61.
14. Travis WD, Davis GE, Tsokos M, Lebovics R, Merrick H, Miller S, et al. Multifocal verruciform xanthoma of the upper aerodigestive tract in a child with a systemic lipid storage disease. Am J Surg Pathol. 1989;13:309-16.
15. Pobet E, McCaden ME, Santa Cruz D. Cystic verruciform xanthoma. J Am Acad Dermatol. 1991;25:330-1.
16. Ersahin C, Szpaderska AM, Foreman K, Yong S. Verucciform xanthoma of the penis not associated with human papillomavirus infection. Arch Pathol Lab Med. 2005;129:e62-4. 17. Mannes KD, Deckle CL, Requena L, Sangueza OP. Verruciform xanthoma associated with squamous cell carcinoma. Am J Dermatopathol. 1999;21:66-9. 18. Hu JA, Li YN, Li SY, Ying H. Study of the clinicopathology of verruciform xanthoma of the oral cavity. Shangai J Stomatol. 2005;14:370-3. 19. Jensen JL, Shu –Yuan L, Jeffes III EWB. Verruciform xanthoma of the ear with coexisting epidermal dysplasia. Am J Dermathopatol. 1992;14:426-30.
20. Khaskhely NM, Uezato H, Kamiyama Y, Maruno M, Kariya K, Oshiro M et al. Association of Human Papillomavirus type 6 with a verruciform xanthoma. Am J Dermatopathol. 2000;22:447-52.
21. Barr RJ, Plank CJ. Verruciform xanthoma of the skin. J Cutan Pathol. 1980;7:422-8.
22. Meyers DC, Woosley JT, Reddick RL. Verruciform xanthoma in association with discoid lupus erythematosus. J Cutan Pathol. 1992;19:156-8.
23. Cooper TW, Santa Cruz DJ, Bauer EA. Verruciform xanthoma. Ocurrence in eroded skin in a patient with recessive dystrophic epidermolysis bullosa. J Am Acad Dermatol. 1983; 8:463-7.
24. Murat-Sušic S, Paštar Z, Dobric I, Camino A, Hutinec Z, Husar K, et al. Verruciform xanthoma in recessive dystrophic epidermolysis bullosa Hallopeau-Siemens. Int J Dermatol. 2007;46:955-9.
25. Gehrig RD, Baughman RA, Collins JF. Verruciform xanthoma in a young male patient with a past history of pemphigus vulgaris. Oral Surg. 1983;55:58-61.
26. Snider RL. Verruciform xanthoma and lymphedema. J Am Acad Dermatol. 1992;27:1021-3.
27. Ide F, Obara K, Yamada H, Mishima K, Saito I, Kusama K. Cellular basis of verruciform xanthoma: immunohistochemical and ultrastructural characterization. Oral Dis. 2008;14:150-7.
28. Balus S, Breathnach AS, O´Grady AJ. Ultraestructural observations on foams cells and the source of their lipid in verruciform xanthoma. J Am Acad Dermatol. 1991;24:760-4.
29. Moshin SK, Lee MW, Amin MB, Stoler MH, Eyzaguirre E, Ma CK, et al. Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells. Am J Surg Pathol. 1998;22:479-87.
30. Sibaud V, Marit G, Deminiere C, Campana F, Taieb A, Fricain JC. Multiple verruciform xanthomas of the oral mucosa associated with graft versus host disease. Ann Dermatol Venereol. 2006;133:995-9.
31. Smith KJ, Skelton H, Angritt P. Changes of verruciform xanthoma in an HIV –1+ patient with diffuse psoriasiform skin disease. Am J Dermatopathol. 1995;17:185-8.
32. Rawal SY, Kalmar JR, Tatakis DN. Verruciform xanthoma: immunohistochemical characterization of xanthoma cell phenotypes. J Periodontol. 2007;78:504-9.
33. Takiwaki H, Yokota M, Ahsan K, Yokota K, Kurokawa Y, Ogawa I. Squamous cell carcinoma associated with verruciform xanthoma of the penis. Am J Dermatopathol. 1996;18:551-3.
34. Sharma D, Pradeep AR. Xanthomatous changes in a case provisionally diagnosed as fibroma: a case report. NY State Dent J. 2007;73:61-3.
35. Baloch ZW, Martin S, LiVolsi VA. Granular cell tumor of the thyroid: a case report. Int Jurnal Surg Pathol. 2005;13:291-4.
36. McKee PH, Calonje E, Granter SR, editores. Connective tissue tumors. In: Pathology of the skin with clinical correlations. Third edition. Philadelphia: Elsevier Mosby; 2005. p. 1779-1781
37. Duray PH, Johnston Y. Verruciform xanthoma of the nose in an elderly male. Am J Dermatopathol. 1986;8:237-40.
2. Nowparast B, Howell FV, Rick GM. Verruciform xanthoma. A clinicopathologic review and report or fifty-four cases. Oral Surg. 1981;51:619-25.
3. Yu CH, Tsai TC, Wang JT, Liu BY, Wang YP, Sun A, et al. Oral verruciform xanthoma: a clinicopathologic study of 15 cases. J Formos Med Assoc. 2007;106:141-7.
4. Weedon D, editor. Cutaneous infiltrates non lymphoid. In: Skin pathology. London: Churchill Livingstone; 2002. p. 1077-8.
5. Mouncastle EA, Lupton GP. Verruciform xanthomas of the digits. J Am Acad Dermatol. 1989;20:313-7.
6. Chyu J, Medenica M, Whitney DH. Verruciform xanthoma of the lower extremity: Report of a case and review of literature. J Am Acad Dermatol. 1997;17:695-7.
7. Neville B. The verruciform xanthoma. A review and report of eight new cases. Am J Dermatopathol. 1986;8:247-53.
8. Philipsen HP, Reichart PA, Takata T, Ogawa I. Verruciform xanthoma-biological profile of 282 oral lesions based on a literature survey with nine new cases from Japan. Oral Oncol. 2003;39:325-36.
9. Hu JA, Li Y, Li S. Verruciform xanthoma of the oral cavity: Clinicopathological study relating to pathogenesis. Report of three cases. APMIS. 2005;113:629-34.
10. Connolly SB, Lewis EJ, Lindholm JS, Zelickson BD, Zachary CB, Tope WD. Management of cutaneous verruciform xanthoma. J Am Acad Dermatol. 2000;42:343-7.
11. Li H, Lambert WC. Verruciform xanthoma. eMedicine Fecha de acceso: 2 de octubre de 2009. Disponible en: http://www. emedicine.com/derm/topic852.htm.
12. Miller AS, Elzay RP. Verruciform xanthoma of the gingiva: report of six cases. J Periodontol. 1973;44:103-5.
13. Hume WJ, Smith CJ, Franklin CD. Verruciform xanthoma. Br J Oral Surg. 1980;18:157-61.
14. Travis WD, Davis GE, Tsokos M, Lebovics R, Merrick H, Miller S, et al. Multifocal verruciform xanthoma of the upper aerodigestive tract in a child with a systemic lipid storage disease. Am J Surg Pathol. 1989;13:309-16.
15. Pobet E, McCaden ME, Santa Cruz D. Cystic verruciform xanthoma. J Am Acad Dermatol. 1991;25:330-1.
16. Ersahin C, Szpaderska AM, Foreman K, Yong S. Verucciform xanthoma of the penis not associated with human papillomavirus infection. Arch Pathol Lab Med. 2005;129:e62-4. 17. Mannes KD, Deckle CL, Requena L, Sangueza OP. Verruciform xanthoma associated with squamous cell carcinoma. Am J Dermatopathol. 1999;21:66-9. 18. Hu JA, Li YN, Li SY, Ying H. Study of the clinicopathology of verruciform xanthoma of the oral cavity. Shangai J Stomatol. 2005;14:370-3. 19. Jensen JL, Shu –Yuan L, Jeffes III EWB. Verruciform xanthoma of the ear with coexisting epidermal dysplasia. Am J Dermathopatol. 1992;14:426-30.
20. Khaskhely NM, Uezato H, Kamiyama Y, Maruno M, Kariya K, Oshiro M et al. Association of Human Papillomavirus type 6 with a verruciform xanthoma. Am J Dermatopathol. 2000;22:447-52.
21. Barr RJ, Plank CJ. Verruciform xanthoma of the skin. J Cutan Pathol. 1980;7:422-8.
22. Meyers DC, Woosley JT, Reddick RL. Verruciform xanthoma in association with discoid lupus erythematosus. J Cutan Pathol. 1992;19:156-8.
23. Cooper TW, Santa Cruz DJ, Bauer EA. Verruciform xanthoma. Ocurrence in eroded skin in a patient with recessive dystrophic epidermolysis bullosa. J Am Acad Dermatol. 1983; 8:463-7.
24. Murat-Sušic S, Paštar Z, Dobric I, Camino A, Hutinec Z, Husar K, et al. Verruciform xanthoma in recessive dystrophic epidermolysis bullosa Hallopeau-Siemens. Int J Dermatol. 2007;46:955-9.
25. Gehrig RD, Baughman RA, Collins JF. Verruciform xanthoma in a young male patient with a past history of pemphigus vulgaris. Oral Surg. 1983;55:58-61.
26. Snider RL. Verruciform xanthoma and lymphedema. J Am Acad Dermatol. 1992;27:1021-3.
27. Ide F, Obara K, Yamada H, Mishima K, Saito I, Kusama K. Cellular basis of verruciform xanthoma: immunohistochemical and ultrastructural characterization. Oral Dis. 2008;14:150-7.
28. Balus S, Breathnach AS, O´Grady AJ. Ultraestructural observations on foams cells and the source of their lipid in verruciform xanthoma. J Am Acad Dermatol. 1991;24:760-4.
29. Moshin SK, Lee MW, Amin MB, Stoler MH, Eyzaguirre E, Ma CK, et al. Cutaneous verruciform xanthoma: a report of five cases investigating the etiology and nature of xanthomatous cells. Am J Surg Pathol. 1998;22:479-87.
30. Sibaud V, Marit G, Deminiere C, Campana F, Taieb A, Fricain JC. Multiple verruciform xanthomas of the oral mucosa associated with graft versus host disease. Ann Dermatol Venereol. 2006;133:995-9.
31. Smith KJ, Skelton H, Angritt P. Changes of verruciform xanthoma in an HIV –1+ patient with diffuse psoriasiform skin disease. Am J Dermatopathol. 1995;17:185-8.
32. Rawal SY, Kalmar JR, Tatakis DN. Verruciform xanthoma: immunohistochemical characterization of xanthoma cell phenotypes. J Periodontol. 2007;78:504-9.
33. Takiwaki H, Yokota M, Ahsan K, Yokota K, Kurokawa Y, Ogawa I. Squamous cell carcinoma associated with verruciform xanthoma of the penis. Am J Dermatopathol. 1996;18:551-3.
34. Sharma D, Pradeep AR. Xanthomatous changes in a case provisionally diagnosed as fibroma: a case report. NY State Dent J. 2007;73:61-3.
35. Baloch ZW, Martin S, LiVolsi VA. Granular cell tumor of the thyroid: a case report. Int Jurnal Surg Pathol. 2005;13:291-4.
36. McKee PH, Calonje E, Granter SR, editores. Connective tissue tumors. In: Pathology of the skin with clinical correlations. Third edition. Philadelphia: Elsevier Mosby; 2005. p. 1779-1781
37. Duray PH, Johnston Y. Verruciform xanthoma of the nose in an elderly male. Am J Dermatopathol. 1986;8:237-40.
How to Cite
1.
Arias VL, Rodríguez G. Verruciform xanthoma: histopathologic findings and pathogenesis. Analysis of vulvar and perianal cases. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 26 [cited 2024 Jul. 22];18(3):160-5. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/327
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2019-02-26
How to Cite
1.
Arias VL, Rodríguez G. Verruciform xanthoma: histopathologic findings and pathogenesis. Analysis of vulvar and perianal cases. rev. asoc. colomb. dermatol. cir. dematol. [Internet]. 2019 Feb. 26 [cited 2024 Jul. 22];18(3):160-5. Available from: https://revista.asocolderma.org.co/index.php/asocolderma/article/view/327
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